Intrathecal baclofen pump failure due to pain-induced autonomic dysreflexia

Intrathecal baclofen (ITB) therapy is an established treatment for severe refractory spasticity. Although a positive ITB trial confirms efficacy, long-term success can sometimes be limited by mechanical or hardware complications. We describe a patient with multiple sclerosis (MS) and spastic quadriplegia who underwent ITB pump implantation in the posterolateral flank region, a non-standard site selected due to anatomical limitations. The pump provided marked spasticity relief, allowing discontinuation of oral antispasmodics. However, within weeks, the patient developed persistent pump-site pain and recurrent autonomic dysreflexia (AD), an uncommon manifestation in MS that was resistant to treatment. Infectious and other mechanical causes were excluded, and clinical assessment determined that pain from the atypical pump placement was the likely precipitant. The pump was explanted 1 month later, resolving the patient's AD but resulting in recurrence of severe spasticity. This case underscores the need for individualised pump planning to prevent hardware-related complications.